Individual
JENELLE NIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
604 W NORTH AVE, ADA, OH 45810-1041
(419) 634-0431
Mailing address
604 W NORTH AVE, ADA, OH 45810-1041
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.19255
OH
Other
Enumeration date
07/21/2016
Last updated
10/18/2024
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